Heart attacks - where women miss out

We women have a lot to put up with - having babies, juggling home and career, being the only member of the family who remembers birthdays or notices that the bin is full. But one thing we don't need to worry about quite as much as men is heart attack. In fact, in the last 50 years, death rates from heart disease among British women have dropped by three quarters, and they halved among women in their 50s in the last three decades of the 20th century alone.

You all know the symptoms of a heart attack, right? Unbearable crushing central chest pain, like a band around your chest, and feeling sweaty and looking deathly pale? Not necessarily if you're a woman.

More than two in five women who have a heart attack don't have any kind of chest discomfort, and one in three describe a sensation of 'pressure' rather than 'pain' in their chest.Many people don't realise it's possible to have a heart attack without this pain, so women might delay seeking help.

What women need to know - other possible symptoms of heart attack

Women having a heart attack get get a vague discomfort over the lower chest, or possibly in the upper tummy (which can be mistaken for indigestion) more often than men. They often also get these possible symptoms:

A heart attack is a complete blockage of one of the blood vessels which supply blood to the heart muscle. In angina, blood supply is seriously reduced but not completely blocked. Symptoms are similar to those of heart attack but they may be less severe and they tend to settle on their own. However, if you've never had angina before, it is important to seek medical help urgently - angina is an early warning sign that you're at higher risk of heart attack. Getting help early can stop your condition progressing to the 'real thing'.

Why the rush? Why heart attack is an emergency

As we've heard, when you have a heart attack the blood supply to part of your heart muscle is blocked. No blood means no oxygen, and if this lasts long enough, heart muscle is damaged beyond repair. Fortunately, huge advances have been made in recent years in the early treatment of heart attack, which have improved survival rates dramatically. In the short term, treatments include 'clotbuster' medicines to break down the blood clot blocking the artery. Surgery (often carried out using probes guided into the heart arteries through the skin under X-ray control, with no need to cut the chest open at all) can also be used to open the artery and put in a tiny metal 'stent' to prevent it from blocking again.

Recovering from a heart attack - one step at a time

Getting over a heart attack completely can take months, but you'll have a rehabilitation team to help you every step of the way. While you're in hospital, they'll assess your risk factors and how you can cut your chance of another heart attack. They'll advise on building up exercise and activity levels gradually and safely. Ask about a cardiac rehabilitation programme at your local hospital. The DVLA recommends that you don't drive for four weeks after a heart attack, but you don't need to inform them if you have a standard driving licence.

Long-term health

In the longer term, lifestyle steps to look after your heart will hugely cut your chance of another heart attack. However, if you've had a heart attack or angina, you are at higher risk in the future, so your doctors will recommend other medicines to protect you as well. These include statins to lower cholesterol, blood pressure tablets and medicine to reduce the chance of your arteries blocking again in future.

Can tests tell me if I'm at risk?

High cholesterol and blood pressure are among the biggest risk factors for heart attack and stroke. Unfortunately, neither of them causes any warning symptoms except in very exceptional cases. That means you won't know you're affected unless you get checked out. You should get your blood pressure checked at least every five years if you're over 40, and more often if your doctor advises.

Blood pressure and cholesterol-lowering medicines can dramatically cut your risks, but you do need to take them regularly. If you have side effects, speak to your GP rather than just stopping - they may be able to advise on an alternative that suits you better.

Alcohol - does it help?

I'm always hearing from my patients that red wine protects against heart disease. It might, a bit, if you're a man over 40 or a woman past the menopause. But you only need a small amount - drinking more than 14 units a week can raise your risk instead. Other risks from alcohol, such as breast cancer, start to rise even at low levels (one unit a day can raise your risk of breast cancer by 7-11%). So I certainly wouldn't recommend taking up drinking for the sake of your heart.

Your heart will thank you for any move towards a Mediterranean diet - more fruit and veg, less 'saturated' fat like red meat and high-fat dairy foods, more fish (especially oily fish), 'unrefined' carbohydrates like wholemeal and wholegrain foods, and regular nuts or olive oil. This diet has been proved to cut the risk of heart disease. So can regular exercise - half an hour a day of any aerobic exercise (the kind that makes you slightly breathless) will help. In fact, so will any small changes - taking the stairs rather than the lift, walking to the shops instead of taking the car or even parking at the far end of the car park!

HRT and heart attack - what should I believe?

We all know that younger women have a lower risk of heart attack than men, and it's long been assumed that female hormones - oestrogen in particular - played a part in protecting them. It was always thought that replacing oestrogen with HRT after the menopause would cut that risk. But a few years ago, a big study suggested women given HRT had more heart attacks than those who didn't take it.

So what's the truth? Well, the world has turned full circle, as it so often does in medicine. The women in the study were mostly in their 60s, and many had gone through the menopause many years earlier. They were also already at very high risk of heart attack because of high blood pressure, raised cholesterol etc. Among women in their 50s (the age doctors usually start giving HRT), women taking HRT weren't put at higher risk of heart attack by taking it. However, while that's one worry off your mind, taking HRT long term is still thought to increase your risk of breast cancer, so do talk to your GP about your own case.

With thanks to 'My Weekly' magazine where a version of this article was originally published.

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Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

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